Article
Characteristics of guidelines that affect uptake in clinical practice: Results of a realist review on guideline implementability
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Authors
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M. Kastner
- St. Michael's Hospital - Li Ka Shing Knowledge Institute, Toronto, Canada
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L. Hayden
- St. Michael's Hospital - Li Ka Shing Knowledge Institute, Toronto, Canada
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J. Makarski
- Department of Oncology - McMaster University, Hamilton, Canada
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L. Durocher
- Department of Oncology - McMaster University, Hamilton, Canada
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A. Chatterjee
- St. Michael's Hospital - Li Ka Shing Knowledge Institute, Toronto, Canada
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L. Perrier
- St. Michael's Hospital - Li Ka Shing Knowledge Institute, Toronto, Canada
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E. Estey
- Strategic Policy, Planning & Initiatives, Health Services, Region of Peel, Toronto, Canada
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M. Brouwers
- Department of Oncology - McMaster University, Hamilton, Canada
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O. Bhattacharyya
- St. Michael's Hospital - Li Ka Shing Knowledge Institute, Toronto, Canada
| Published: | July 10, 2012 |
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Outline
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Background: Guidelines have the potential to facilitate implementation of evidence into practice but this has not been consistently achieved. Optimizing the intrinsic characteristics of guidelines may be one way of increasing their impact.
Objective: To conduct a realist review to understand “what works for whom, in what circumstances” in guideline implementation.
Methods: Realist review was used to explore the concept of guideline implementability across the disciplines of medicine, psychology, management, and human factors engineering. The iterative search strategy included expert-identified, purposive and bibliographic searching. Articles were selected based on what new knowledge they brought to our understanding. Data analysis included identifying relevant guideline attributes describing their relationship with uptake, the strength of that association, any tradeoffs, and the context in which they were studied.
Results: Of 320 articles reviewed independently and in duplicate, 240 articles (75%) were identified as relevant. Two researchers extracted primary data, and another 2 researchers performed an auditing strategy to verify this data. The 1045 identified guideline attributes were classified into 28 categories across 5 dimensions: language, format evidence, feasibility, and decision-making.
Discussion: The review informed a framework of implementability depicting attribute tradeoffs and their relationship with uptake, indicating that improving some of these dimensions will worsen others.
Implications for guideline developers/users: Findings represent an important step to identify guideline attributes that could improve uptake by clinicians and are modifiable by guideline developers. Next steps include developing a tool to incorporate these concepts into the design of guideline recommendations.
